Life Renewing Center

Personal Information

Name *

First

Middle

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Gender *

Age *

Ethnicity *

Height: feet *

inches *

Weight (in lbs) *

Marriage & Children

Marital Status *

Number of Past Marriages *

Number of Children *

Do You Want Any Children? *

Career, Politic View, & Religion

Profession *

Education Level *

Income

Religion *

Political View *

Habits & Hobbies

Do you drink? *

Do you smoke? *

Do you do drugs? *

Do you have/want pets?

What kind of pets? *

Please specify *

Hobbies *

Dating & Relationship

How long is the longest relationship you have been in? *

When it comes to dating, what best describes your interest? *

Describe Your Perfect Match *

Your Match's Age: Min *

Max *

How Would You Describe Yourself *

References

Please provide 2 references. We will contact them by phone as part of the club member evaluation process.

Name *

First

Last

Phone *

Email

Reference #2 *

First

Last

Phone *

Email

Documents (max file sizes 2MB)

Current Photo *

Click or drag a file to this area to upload.

A photo appropriate to show a child is appreciated.

ID (Drivers License, Green Card, Passport, etc) *

I have emailed a copy of my ID to singles@liferenewingcenter.org

For all club members' safety, we require a copy of your identity document. For your safety, we are collecting the document via email.

Terms & Condition

By clicking submit, I agree to the following requirements. *

I read and agree to the following requirements *

1. You must have strong moral values, be honest, polite, and compassionate, and you are free of substance abuse or anger-management problems.
2. Fill out the YouShineClub application form truthfully. False information is strictly prohibited.
3. Provide a copy of US drivers license, green-card or other ID such as a passport.
4. Provide recommendations from at least two friends or family members who can confirm that you are single.
5. Commit to online and in-person participation in most singles’ network events held by YouShineClub.
6. You must be 28 years or older.
7. If accepted to the program, you agree to pay $99 for the first year, and $2,999 annually thereafter if you choose to renew (i.e. we don't want you to stay XD).

Apply to YouShine Club

Personal Information

Marriage & Children

Career, Politic View, & Religion

Habits & Hobbies

Dating & Relationship

References

Documents (max file sizes 2MB)

Terms & Condition